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Psych_Resident said:
What are people's thoughts on doing two fellowships? My initial thought was that doing one (addiction) might make me a more competitive candidate for a second (e.g. consult-liaison); more experience, skills, maybe opening doors at a more prestigious institution/program than I would be able to attain right out of residency ... but I also wonder whether this would make me look indecisive and effectively less competitive? I'm not as concerned about the opportunity cost of delaying attending salary.
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Barely 2/3 of CL fellowships fill. All you need to land a spot is to be breathing and not have active criminal charges. Do the fellowship you actually want to do.
 
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The biggest downside of fellowship is giving up the salary and autonomy you get as an attending. You also lose a year (per fellowship) of doing whatever you would otherwise do, and the longer you stick with a job (whether private practice, an academic medical center, a healthcare system, etc.) the more opportunities come up and the greater your ability to tailor your job to your interests. This, of course, is a generalization and some jobs are relatively dead-end in terms of advancement or positive shaping.

Other than child and to a lesser extent forensics we get the training to practice in all these settings. We are (fortunately) not like pathology where a fellowship or two is often needed to find work in desirable locations. And as Celexa said, for C-L you have a good shot at very desirable locations without needing to add an addictions fellowship before that. You also will need think carefully about how you will feel doing two more years of low-paid, low-autonomy work. You should also realize that taking a job in your area of interest and receiving some mentorship from those with more experience can work out very well. For addiction I believe you are too late to make the cut for the practice pathway (expiring 2025) but it's worth double-checking to see if you could squeeze it in with one year of addiction attending work.

With all that said, I do believe fellowships offer genuine value (as long as they are good ones). You will get many hours of didactics on the topic, work with highly skilled faculty, see a greater range and depth of patients in your chosen field, and get to spend time focusing on honing your skills. I personally think that, for instance, if you feel convinced you want a career in addictions or C-L that doing a fellowship in one or the other can be very much worth it. Doing two, though, is probably a bit much. The main niche I could think of there would be working on an addiction-specific consult service, but if it were me pursuing that goal I would probably still just do one or the other and then start and grow in the attending role.
 
I planned on doing 2 fellowships and actually applied for 2, but ended up just doing one. Most people (even in academics) discouraged me from doing 2 fellowships saying it wasn't necessary and that I could meet my goals in other ways. In the end, I wasn't able to do the 2nd fellowship for visa reasons and it has not had any adverse impact on my career and I'm glad I didn't. It would have been a great experience to do the fellowship I wanted to do, and may have made some impact to be able to work with those people who were the world experts in that field, but I have still carved out that niche for myself and provide consultations internationally in that subspecialty. Also,doing one fellowship won't necessarily make you more competive for a 2nd - some PDs will see it as a negative and think of you as a dilettante.

I have seen people who have done really well with doing 2 or more fellowships but that isn't the only path. You want to make sure it makes sense or there is a specific end goal in mind. For example doing CAP and addictions, or CAP and forensics could be good but doing CAP and geropsych probably doesn't make much sense. Doing pain with CAP or forensics could be a boon, but doing pain and addictions actually makes much less sense than you might think. I know some people who have done both C-L and addictions fellowship and it may have helped more quickly become director for an addictions consult service, but I am not convinced there is much advantage to this combination except for your intellectual curiosity and interest.

I'll also mention beyond the 5 main fellowships, there are several other accredited and non-accredited fellowship options including sleep, pain, hospice and palliative medicine, behavioral neurology & neuropsychiatry, brain injury medicine, public psychiatry, movement disorders, headache medicine, clinical informatics, medical genetics, interventional psychiatry, integrative medicine, and reproductive psychiatry/women's mental health.
 
Psych_Resident said:
Well, I'm trying to aim for what are likely competitive locations in coastal cities due to my and my spouse's career and preferences. I also have an interest in both and figure I might clarify my preferences and better explore both in more settings this way.
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If a program has internal candidates who they have already decided on, you might be unable to match a specific program in a specific year. Otherwise, things are so uncompetitive that if you have any modicrum of geographic flexibility, you will be fine.
 
splik said:
I planned on doing 2 fellowships and actually applied for 2, but ended up just doing one. Most people (even in academics) discouraged me from doing 2 fellowships saying it wasn't necessary and that I could meet my goals in other ways.
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How do you meet your goals in other ways effectively?

I'm doing CAP and I had some thoughts about doing CL after but I'm not sure I actually want to go through another fellowship if it's not necessary.
 
shoomer said:
How do you meet your goals in other ways effectively?

I'm doing CAP and I had some thoughts about doing CL after but I'm not sure I actually want to go through another fellowship if it's not necessary.
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What setting(s) do you want to work in? If you're cap trained, adding CL will likely only matter if you want to attend on adult CL services in academic settings, or if you are dead set doing academic child CL where there aren't many positions and are competing with triple boarders.
 
One thing that I have sometimes thought about for psych fellowships is offering the options of part time. I am aware of palliative fellowships that have let attendings coming in essentially do half time on the fellowship and half time in their attending role, and I think it's likely that some CL programs could be pursuade to do a similar thing. It's still an opportunity cost but since most CL fellowships don't involve call, it isn't quite the same degree of delayed gratification.
 
Psych_Resident said:
What are people's thoughts on doing two fellowships? My initial thought was that doing one (addiction) might make me a more competitive candidate for a second (e.g. consult-liaison); more experience, skills, maybe opening doors at a more prestigious institution/program than I would be able to attain right out of residency ... but I also wonder whether this would make me look indecisive and effectively less competitive? I'm not as concerned about the opportunity cost of delaying attending salary.
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You'll likely never make up the difference from a dollar and cent perspective but since your ok with it then go for it.
 
I did two and would not recommend it. My first fellowship (non-ACGME) was an invaluable year of training and more than justified the lost year of attending wages. However, doing that fellowship did not open up doors to a more prestigious second fellowship (ACGME) and frankly, I would have gotten better training in the second field had I just studied on my own and went to the annual subspecialty conference one or two times.

My feelings may have been different had I gotten good training during my second fellowship but I can only speak from my own experience and it's decidedly not worth it.
 
A fellowship isn’t going to make you more competitive for a 2nd fellowship. Psych fellowships are already not very competitive. Competition is primarily based on internal applicants.

If your Yale fellowship has 3 positions and Yale general psych has 4 internal applicants applying for those 3 positions, your chances are likely 0% even if you published 10 times from Harvard. That same fellowship may struggle to fill next year if it has no internal applicants.

I talked to a fellowship director from a top 25 psych program a few years back. At the time, his fellowship had 0 applicants multiple years in a row. He joked that he would call someone to interview if they half completed the application.
 
The OP has a really skewed perspective and I don't understand where it's coming from. Do attendings at their program actually recommend this course of action? What kind of possible coastal place or program could they be going that would care about more than completing residency and the medical license? Look, if the OP really want to do academics, which is the only thing I can see maybe giving the OP this kind of extremely out of touch perspective...you still do not need two fellowships, or even one fellowship unless you want to teach that particular fellowship (and even then probably not). Here's the thing, coastal places are expensive to live in and the jobs there don't often (or ever) pay enough to fully make up the cost of living difference. Sure, lots of people want to live in coastal places for good reason, but these salaries keep competition down. Academic jobs are, by far, the worst of the bunch for pay since they consider prestige a part of compensation package. No matter what city you want to go to and honestly, no matter program or facility you want to get a job at...you probably can with just completing residency. The job market is just that employee driven. It's kind of bizarre that the OP seems to downplay the importance of attending salary...never forget compound interest. It matters a lot over the course of a career. Two fellowships are likely to be ignored by the vast majority of hiring managers since they really are just looking to fill the position with anybody. Fellowship positions themselves DEFINITELY don't care about your other fellowship since they need to just fill their slots most of all. I swear, the OP's whole mindset really keeps physicians down as a profession and stops us from seeing our worth. 4 years undergrad, 4 years med school and 4 years residency wasn't enough post secondary education?
 
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I tend to agree with comp1, but I sympathize with the OP. I was the only member of my residency class who didn't go directly into formal fellowship. When you are in a larger academic center, and all your pals in medicine are doing fellowships, it can feel like that's just the next step.

I am glad I didn't do a CL fellowship and I look forward to leaving CL work behind forever soon.

For ever, and ever.
 
TheRightMedication said:
I tend to agree with comp1, but I sympathize with the OP. I was the only member of my residency class who didn't go directly into formal fellowship. When you are in a larger academic center, and all your pals in medicine are doing fellowships, it can feel like that's just the next step.

I am glad I didn't do a CL fellowship and I look forward to leaving CL work behind forever soon.

For ever, and ever.
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I doubt the OP is at a major academic center, though, or they'd likely know more about the process and the current state of the field.

I don't have anything but anecdata to back this but at my residency, a big academic center which historically had sent lots of people to fellowship, it was like Covid drained everyone's desire. People were so burnt out everyone just wanted to get out and earn money. Many, many fewer people sought or are seeking fellowships these last two years compared to years before.

I stayed in academia because teaching is my passion, but I understand full well what I'm giving up by going that route. I agree with comp1 doctors need to be better at recognizing their own value.
 
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An "attending pay check" is lower than almost any job offer you can find as a grown up board certified psychiatrist, but it is a lot better than a PGY-V or PGY-VI pay check. Fellowships do open academic doors, but two only makes sense if you want to be a child forensic specialist. If so fast track and do child first to save you a year. The dirty secret truth is that getting into a good academic job with quality mentors around you is better than a fellowship if you get the right job. It can be like being in several fellowships over time and getting paid better while this happens. Honestly, once you have been in academics and have a reputation and a scholarly interest, no one will ask you what your training was. It would be like asking medical student applicants where they went to high school.
 
Two fellowships is like a second PHD - you have to not want to grow up.

If you want to be competitive and break into prestigious institutions... you need to actually be valuable. Churn out papers. Work with big wigs. Bring in grant money. This is how you actually become valuable, academically.

If you just want a random job at a prestigious institution - go for it. They are hiring. They will pay you peanuts, and you can feel good about it.
 
Bartelby said:
The biggest downside of fellowship is giving up the salary and autonomy you get as an attending. You also lose a year (per fellowship) of doing whatever you would otherwise do, and the longer you stick with a job (whether private practice, an academic medical center, a healthcare system, etc.) the more opportunities come up and the greater your ability to tailor your job to your interests. This, of course, is a generalization and some jobs are relatively dead-end in terms of advancement or positive shaping.

Other than child and to a lesser extent forensics we get the training to practice in all these settings. We are (fortunately) not like pathology where a fellowship or two is often needed to find work in desirable locations. And as Celexa said, for C-L you have a good shot at very desirable locations without needing to add an addictions fellowship before that. You also will need think carefully about how you will feel doing two more years of low-paid, low-autonomy work. You should also realize that taking a job in your area of interest and receiving some mentorship from those with more experience can work out very well. For addiction I believe you are too late to make the cut for the practice pathway (expiring 2025) but it's worth double-checking to see if you could squeeze it in with one year of addiction attending work.

With all that said, I do believe fellowships offer genuine value (as long as they are good ones). You will get many hours of didactics on the topic, work with highly skilled faculty, see a greater range and depth of patients in your chosen field, and get to spend time focusing on honing your skills. I personally think that, for instance, if you feel convinced you want a career in addictions or C-L that doing a fellowship in one or the other can be very much worth it. Doing two, though, is probably a bit much. The main niche I could think of there would be working on an addiction-specific consult service, but if it were me pursuing that goal I would probably still just do one or the other and then start and grow in the attending role.
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Practice pathway requires 2 yrs of practice outside of training. Basically at best, it mayyyy be possible to do it as a 2023 grad, but otherwise seems unlikely unless they extend it again, which is probably unlikely.

mistafab said:
Two fellowships is like a second PHD - you have to not want to grow up.

If you want to be competitive and break into prestigious institutions... you need to actually be valuable. Churn out papers. Work with big wigs. Bring in grant money. This is how you actually become valuable, academically.

If you just want a random job at a prestigious institution - go for it. They are hiring. They will pay you peanuts, and you can feel good about it.
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Honestly, I would argue that even in more competitive locations, you do not necessarily need this for C/L or Addiction.
 
hallowmann said:
Practice pathway requires 2 yrs of practice outside of training. Basically at best, it mayyyy be possible to do it as a 2023 grad, but otherwise seems unlikely unless they extend it again, which is probably unlikely.


Honestly, I would argue that even in more competitive locations, you do not necessarily need this for C/L or Addiction.
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Agree.

I guess it is a little unclear if OP intends to just be hired to do work, or if he wants to 'make it' in academics. The paths are a little different - but have almost nothing to do with 2 fellowships.
 
Forensics isn't a bad idea. It's pretty much the only one where you'll be asked about having done it every single day.
 
CAP and in some cases forensics are the only fellowships that seem to have a very strong utility. I suppose pain could have utility if you want to do procedural work, but for non-procedural pain it wouldn't be necessary. Addiction is increasingly desired but only rarely required by addiction-based practices. Rarely would you need to combine any two of the above, which would basically be child+forensic or child+addiction.
 
Mad Jack said:
CAP and in some cases forensics are the only fellowships that seem to have a very strong utility. I suppose pain could have utility if you want to do procedural work, but for non-procedural pain it wouldn't be necessary. Addiction is increasingly desired but only rarely required by addiction-based practices. Rarely would you need to combine any two of the above, which would basically be child+forensic or child+addiction.
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I generally agree but will say that even in CAP most of the big-wig addiction folks only did CAP and not the additional addiction fellowship. It's easy to get into academic CAP addiction work without the second fellowship. Folks may get the additional certification through the practice pathway but even that I would argue is not necessary. A lot of CAP folks spurn addiction work (even though it's unfortunately an increasing part of the field), so it's pretty easy to break into.

Child + forensic is easily the best dual fellowship if you want to be in a courtroom regularly and see mostly kids.
 
Merovinge said:
I generally agree but will say that even in CAP most of the big-wig addiction folks only did CAP and not the additional addiction fellowship. It's easy to get into academic CAP addiction work without the second fellowship. Folks may get the additional certification through the practice pathway but even that I would argue is not necessary. A lot of CAP folks spurn addiction work (even though it's unfortunately an increasing part of the field), so it's pretty easy to break into.

Child + forensic is easily the best dual fellowship if you want to be in a courtroom regularly and see mostly kids.
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Oh you don't need it, just saying I could see *some* utility. You don't even need addiction for adults, but if you have addiction AND child you would be like... As marketable as they come. Would make it very easy to market your services to very well-to-do clientele
 
Merovinge said:
Child + forensic is easily the best dual fellowship if you want to be in a courtroom regularly and see mostly kids.
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the question is… is it though? Most forensic fellowship is going to be NGRI, competency restoration, SVP etc in adults. Not going to give you specific child-related forensic training in general. Not sure forensics fellowship will actually help if you want to do that.
 
mistafab said:
the question is… is it though? Most forensic fellowship is going to be NGRI, competency restoration, SVP etc in adults. Not going to give you specific child-related forensic training in general. Not sure forensics fellowship will actually help if you want to do that.
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This is not an accurate representation of a typical fellowship at all. There are some programs where there is more of a child component or they allow for that for CAP folks (eg Davis, Yale). we had to do more child evals than I liked in my fellowship.

At any rate the general skills in report preparation, thinking through legal aspects, and testimony and what’s most helpful about forensic fellowship.
 
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